Subject Matter Expert (SME) – Medical Biller | WFH | Nightshift

The Medical Billing SME is responsible for providing deep domain expertise across the end-to-end medical billing lifecycle, ensuring accurate, compliant, and efficient revenue cycle operations. The role acts as the go-to authority for complex billing scenarios, process optimization, and escalations, driving improvements in billing accuracy, denial reduction, and cash flow.

Key Responsibilities

End-to-End Revenue Cycle Ownership

• Oversee and support the entire billing lifecycle:

o Patient registration & insurance verification

o Charge capture & medical coding (ICD-10, CPT, HCPCS)

o Claims preparation, scrubbing, and submission

SME & Escalation Management

• Handle complex and escalated billing issues, including denied or rejected claims

• Perform root cause analysis of billing discrepancies and payer rejections

• Provide payer-specific expertise (Medicare, Medicaid, Commercial)

Denials & AR Optimization

• Analyze and resolve denied claims, ensuring timely re-submission and recovery

• Identify trends in denials and implement preventive measures

Training & Knowledge Leadership

• Train and mentor billing teams on:

o End-to-end RCM processes

o Denial management strategies

o Coding and billing best practices

Qualifications & Experience

• Minimum 5–8+ years in medical billing / revenue cycle management

• Proven experience in end-to-end billing processes

• Prior experience as SME / Team Lead / Quality Analyst preferred

• Certifications (preferred but not mandatory):

o CPC (Certified Professional Coder)

o CCS / CCS-P

o RHIT / RHIA

Technical Skills

• Strong knowledge of:

o Medical billing lifecycle (E2E RCM)

o ICD-10, CPT, HCPCS coding frameworks

o Claims processing and payer adjudication

• Experience with:

o EHR/EMR systems and billing platforms

o Denial management and AR tools